Bisacodyl

Class: Cathartics and Laxatives
ATC Class: A06AB02
VA Class: GA209
CAS Number: 603-50-9
Brands: Alophen Pills, Bisac-Evac, Carter’s Little Pills, Correctol, Dulcolax, Feen-A-Mint, Fleet Bisacodyl, Bisacodyl Uniserts, Fleet Bisacodyl Enema, Dulcolax Bowel Prep Kit, Fleet Prep Kit, LoSo Prep Kit, Tridrate Bowel Evacuant Kit

REMS:

FDA approved a REMS for bisacodyl to ensure that the benefits of a drug outweigh the risks. However, FDA later rescinded REMS requirements. See the FDA REMS page () or the ASHP REMS Resource Center ().

Introduction

Bisacodyl, a diphenylmethane laxative, is a stimulant laxative.^{b c e}

Uses for Bisacodyl

Constipation

Used as a stimulant laxative to relieve occasional constipation.^{a c e f g h i}

Has a more pronounced laxative effect than mild laxatives (e.g., anthraquinones such as cascara sagrada [no longer commercially available in the US]) but less pronounced than the violent purgation produced by castor oil.^c

Use of stimulant laxatives for simple constipation is seldom necessary or desirable.^c

If a stimulant laxative is used, senna derivatives may be preferred.^c

Used to treat constipation that occurs following prolonged bed rest or hospitalization.^c

Used to treat chronic constipation associated with opiate therapy.^e

Because bisacodyl may be distributed into milk, other laxatives usually are preferred for postpartum constipation.^c

Stimulant laxatives have been used to treat constipation resulting from diminished colonic motor response in geriatric patients but, because this type of constipation is frequently due to psychological or physical laxative dependence, the bulk-forming laxatives are preferred.^c

Stimulant laxatives are used to treat constipation occurring secondary to idiopathic slowing of transit time, to constipating drugs, or to irritable bowel or spastic colon syndrome.^c

Stimulant laxatives have been used to treat constipation in patients with neurologic constipation.^c

Bowel Cleansing

Used orally and/or rectally (as suppositories or enemas) to empty the bowel prior to surgery or radiographic, proctoscopic, or endoscopic (e.g., sigmoidoscopic, proctoscopic) procedures, when thorough evacuation is essential.^{a c e} Oral therapy often is supplemented with rectal evacuants.^{b c k j}

Used orally or rectally as a laxative for postoperative, antepartum, or postpartum care.ⁱ

Enemas are used to cleanse the colon postoperatively.^{c i}

Suppositories may be used to cleanse the colon in pregnant women prior to delivery if they are given at least 2 hours before onset of the second stage of labor.^c

Usually supplemented with administration of rectal evacuants, such as saline, stimulant, or soapsuds enemas, immediately before radiographic procedures.^c

Bisacodyl tannex is added to barium sulfate enemas to aid in coating the intestinal mucosa and enhance colonic evacuation prior to radiographic examination of the colon.^c

Colostomy Flushing

Has been used to facilitate flushing of colostomies†;^{c e} may reduce or eliminate the need for irrigations.^e

Bisacodyl Dosage and Administration

Administration

Administer orally as delayed-release (enteric-coated) tablets.^{a b f g i j k}

Administer rectally as suspension enemas or as suppositories.^{b h i j k}

Administered as a flush suspension† for colostomies.^{c e}

Oral Administration

Bisacodyl is administered orally.^{a b f g i}

For occasional use as an oral laxative, administer the evening before a morning bowel movement is desired.^b

To avoid gastric irritation and the possibility of vomiting, delayed-release (enteric-coated) tablets must be swallowed whole and not crushed, chewed, or taken within 1 hour of antacids or milk.^{a b e f g}

Rectal Administration

Bisacodyl also is administered rectally as a suppository or enema.^{b h i j k}

Remove the foil wrapper and insert the suppository well into the rectum, pointed end first, and retain for at least 15–20 minutes if possible.^{h j}

Shake bisacodyl enemas well and remove the protective shield from the tip before inserting rectally.ⁱ Lie on left side with left knee slightly bent and the right leg drawn up or be in the knee-chest position and insert the enema tip into the rectum.ⁱ Squeeze the contents of the enema container into the rectum.^j

Bisacodyl tannex is administered rectally as an enema.^b

Rectal suppositories and enemas may be administered at the time a bowel movement is desired.^{b e h i}

Dosage

Pediatric Patients

Constipation

Stimulant laxatives generally avoided in children <6 years of age for occasional constipation,^c unless otherwise directed by a clinician.^{a f g h i}

Oral

Children 3–11 years of age: A single 5- to 10-mg (usually 5-mg) or 0.3-mg/kg dose daily.^{a b f g}

Children ≥12 years of age: A single 5- to 15-mg (usually 10-mg) dose daily.^{a b e f g}

Rectal (enema)

Children ≥12 years of age: A single 10-mg (30-mL) dose daily.ⁱ

Rectal (suppositories)

Children <2 years of age: A single 5-mg (½ suppository) dose daily.^{b e}

Children 2–11 years of age: A single 5- or 10-mg (½ or 1 suppository, respectively) dose daily.^{b e h}

Children ≥12 years of age: A single 10-mg (1 suppository) dose daily.^{b e h}

Bowel Cleansing

Liquid LoSo Prep Kit

Oral and Rectal

Children ≥12 years of age: The regimen begins with liquid meals at prescribed times, followed by scheduled clear liquid intake at various times and scheduled administration of oral laxatives, and concluding with rectal administration of a bisacodyl suppository.^r

Children ≥12 years of age: In the usual regimen, 300 mL of magnesium citrate solution (17.45 g of magnesium citrate) is administered orally at 5:30 p.m. the day before the procedure, followed by 20 mg of bisacodyl orally at 7:30 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository inserted at least 2 hours before the procedure.^r

LoSo Prep Kit

Oral and Rectal

Children ≥12 years of age: The regimen begins with liquid meals at prescribed times, followed by scheduled clear liquid intake at various times and scheduled administration of oral laxatives, and concluding with rectal administration of a bisacodyl suppository.^m

Children ≥12 years of age: In the usual regimen, 18 g of magnesium citrate (1 packet dissolved in 240 mL water per manufacturer’s directions) is administered orally at 5:30 p.m. the day before the procedure, followed by 20 mg of bisacodyl orally at 7:30 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at least 2 hours before the procedure.^m

Tridrate Kit

Oral and Rectal

Children >12 years of age: The regimen begins with a meal (i.e., clear liquids, chicken or turkey white meat sandwich without condiments, skim milk) at a prescribed time, followed by scheduled clear liquid intake at various times and scheduled administration of oral laxatives, and concluding with rectal administration of a bisacodyl suppository.^o

Children >12 years of age: In the usual regimen, 300 mL of magnesium citrate solution is administered orally at 8 p.m. the day before the procedure, followed by 15 mg of bisacodyl orally at 10 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at 7 a.m. the morning of the procedure.^o

Tridrate Dry Kit

Oral and Rectal

Children >12 years of age: The regimen begins with liquid meals at prescribed times, followed by scheduled clear liquid intake at various times and scheduled administration of oral laxatives, and concluding with rectal administration of a bisacodyl suppository.^p

Children >12 years of age: In the usual regimen, 19 g of magnesium citrate (1 packet dissolved in 240 mL water per manufacturer’s directions) is administered orally in 2 divided doses at 6 p.m. and 6:15 p.m. the day before the procedure, followed by 15 mg of bisacodyl orally at bedtime (between 9 p.m. and midnight) the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at 7 a.m. the morning of (at least 2 hours before) the procedure.^p

Adults

Constipation

Oral

Usually, 5–15 mg daily given as a single dose;^{a b f g} some patients may require single daily doses up to 30 mg.^e

Rectal (enema)

A single 10-mg (30-mL) dose daily.ⁱ

Rectal (suppositories)

A single 10-mg (1 suppository) dose daily.^{b e h}

Bowel Cleansing

Up to 30 mg may be given orally when complete evacuation of the colon is required for special procedures.^b

One of the following regimens can be used to clear the bowel prior to surgical, radiographic, or endoscopic procedures.^{j l m} When available, provide patients with a copy of the manufacturers’ instructions, which detail the specific regimen to be employed.^{j l m n o p q}

Bisacodyl Preparation for Barium Sulfate Enemas

Oral and Rectal

Give up to 30 mg of bisacodyl orally the night before the procedure, followed by a 10-mg bisacodyl rectal suppository 1–2 hours before the procedure.^b Do not eat following administration of the tablets.^b

Bisacodyl and Magnesium Citrate Preparatory Regimens

Oral and Rectal

Preparatory regimens using magnesium citrate, which acts mainly on the small intestine, in addition to administration of the usual oral (up to 30 mg) and rectal (10 mg) dose of bisacodyl also have been used.^b

Bisacodyl Antepartum Preparation

Rectal (suppositories)

To cleanse the colon prior to delivery, a single 10-mg bisacodyl rectal suppository is administered at least 2 hours before onset of the second stage of labor.^b

Bisacodyl Tannex Preparatory Enema

Enema

Bisacodyl tannex may be used prior to radiographic examinations or sigmoidoscopic or proctoscopic procedures.^b

Give a residue-free diet the day before the procedure, followed by 30–60 mL of castor oil orally 16 hours before the examination or procedure.^b

Prepare a cleansing enema by dissolving bisacodyl tannex equivalent to 1.5 mg of bisacodyl and 2.5 g of tannic acid (one packet of the commercially available bisacodyl tannex product) in 1 L of lukewarm water.^b

When used as a radiopaque enema adjuvant, bisacodyl tannex equivalent to 1.5–3 mg of bisacodyl (1–2 packets of the commercially available product) is dissolved in 1 L of barium sulfate suspension.^b The concentration of bisacodyl tannex should not exceed 0.5% (2 packets of the commercially available product per L).^b

Administer the cleansing enema containing bisacodyl tannex the day of the procedure.^b

If necessary, repeat the cleansing enema, but total dosage for one entire colonic examination (including the cleansing enema) should not exceed 4.5 mg of bisacodyl and 7.5 g of tannic acid (3 packets of the commercially available preparation), and no more than 6 mg of bisacodyl and 10 g of tannic acid (4 packets of the commercially available product) should be administered during a 72-hour period.^b

Dulcolax Prep Kit

Oral and Rectal

The regimen begins with a liquid meal at a prescribed time, followed by periodic clear liquid intake throughout the day and scheduled administration of oral laxatives, and concluding with rectal administration of a bisacodyl suppository.^k

In the usual regimen, 300 mL of magnesium citrate solution is administered orally at 4 p.m. the day before the procedure, followed by 20 mg of bisacodyl orally at 6 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at 5:30 a.m. the morning of the procedure.^k

Fleet Prep Kits

Oral and Rectal

Available in 2 kit combinations containing bisacodyl tablets, sodium phosphates oral solution, and either a bisacodyl suppository (Fleet Prep Kit 1) or a bisacodyl enema (Fleet Prep Kit 3).^j

Each kit can be administered in regimens beginning 18 or 24 hours before the procedure; in most cases, the 24-hour regimen is followed.^{j s t}

Each regimen begins with a light meal at a prescribed time, followed by scheduled clear liquid intake at various times and scheduled administration of oral laxatives, and concluding with rectal administration of either a bisacodyl suppository or bisacodyl enema 1 hour before leaving for the procedure.^{s t}

In the 24-hour regimen, 45 mL of sodium phosphates oral solution (Fleet Phospho-soda) is mixed with 360 mL of cold clear liquid (ginger ale, apple juice, Sprite, or 7-Up may help improve taste) and administered orally at 4 p.m. the day before the procedure with ≥360 mL (kit 1) or ≥240 mL (kit 3) of clear liquid, followed by 20 mg (or alternative dose per clinician) of bisacodyl orally at 9 p.m. the day before the procedure, and then by either a 10-mg bisacodyl rectal suppository (kit 1) or a 10-mg (30-mL) bisacodyl enema (kit 3) administered 1 hour before leaving for the procedure.^{s t}

Liquid LoSo Prep Kit

Oral and Rectal

The regimen begins with liquid meals at prescribed times, followed by scheduled clear liquid intake at various times and scheduled administration of oral laxatives, and concluding with rectal administration of a bisacodyl suppository.^r

In the usual regimen, 300 mL of magnesium citrate solution (17.45 g of magnesium citrate) is administered orally at 5:30 p.m. the day before the procedure, followed by 20 mg of bisacodyl orally at 7:30 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository inserted at least 2 hours before leaving for the procedure.^r

LoSo Prep Kit

Oral and Rectal

The regimen begins with liquid meals at prescribed times, followed by scheduled clear liquid intake at various times and scheduled administration of oral laxatives, and concluding with rectal administration of a bisacodyl suppository.^m

In the usual regimen, 18 g of magnesium citrate (1 packet dissolved in 240 mL water per manufacturer’s directions) is administered orally at 5:30 p.m. the day before the procedure, followed by 20 mg of bisacodyl orally at 7:30 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at least 2 hours before the procedure.^m

Tridrate Kit

Oral and Rectal

The regimen begins with a meal (i.e., clear liquids, chicken or turkey white meat sandwich without condiments, skim milk) at a prescribed time, followed by scheduled clear liquid intake at various times and scheduled administration of oral laxatives, and concluding with rectal administration of a bisacodyl suppository.^o

In the usual regimen, 300 mL of magnesium citrate solution is administered orally at 8 p.m. the day before the procedure, followed by 15 mg of bisacodyl orally at 10 p.m. the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at 7 a.m. the morning of the procedure.^o

Tridrate Dry Kit

Oral and Rectal

The regimen begins with liquid meals at prescribed times, followed by scheduled clear liquid intake at various times and scheduled administration of oral laxatives, and concluding with rectal administration of a bisacodyl suppository.^p

In the usual regimen, 19 g of magnesium citrate (1 packet dissolved in 240 mL water per manufacturer’s directions) is administered orally in 2 divided doses at 6 p.m. and 6:15 p.m. the day before the procedure, followed by 15 mg of bisacodyl orally at bedtime (between 9 p.m. and midnight) the day before the procedure, and concluding with a 10-mg bisacodyl rectal suppository at 7 a.m. the morning of (at least 2 hours before) the procedure.^p

Special Populations

Hepatic Impairment

No specific dosage recommendations for bisacodyl in hepatic impairment.^{a b f g h i} Minimally absorbed systemically following oral or rectal administration.^{b e}

Renal Impairment

No specific dosage recommendations for bisacodyl in renal impairment.^{a b f g h i} Minimally absorbed systemically following oral or rectal administration.^{b e}

Geriatric Patients

No specific geriatric dosage recommendations for bisacodyl.^a

Cautions for Bisacodyl

Contraindications

• 
  

  Acute abdominal pain, nausea, vomiting, or other symptoms of appendicitis or undiagnosed abdominal pain or rectal bleeding.^{c e}

  
  


• 
  

  Intestinal obstruction.^c

  
  


• 
  

  Bisacodyl tannex: Children <10 years of age.^c

  
  


• 
  

  Do not use kits containing bisacodyl tablets, sodium phosphates oral solution, and bisacodyl suppositories or enemas (Fleet Prep Kits) in patients with megacolon, GI obstruction, perforation, ileus, active inflammatory bowel disease, ascites, CHF, or clinically important renal function impairment or in patients <18 years of age.^{j s t}

  
  

Warnings/Precautions

Warnings

Laxative Dependence

Habit-forming.^c

Potentially serious toxicity with chronic use.^c

Chronic Use or Overdosage

Chronic use or overdosage may produce persistent diarrhea, hypokalemia, loss of essential nutritional factors, and dehydration.^c

Laxative dependence, chronic constipation, and loss of normal bowel function could occur during long-term use.^c

Factitious diarrhea (i.e., severe, chronic, watery diarrhea, frequently occurring at night and accompanied by abdominal pain, weight loss, nausea, and vomiting).^e

Electrolyte disturbances including hypokalemia, hypocalcemia, metabolic acidosis or alkalosis, abdominal pain, diarrhea, malabsorption, weight loss, and protein-losing enteropathy may occur.^c May require immediate medical intervention with appropriate fluid and electrolyte replacement.^j

Electrolyte disturbances may produce vomiting and muscle weakness; rarely, osteomalacia, secondary aldosteronism, and tetany may occur.^c

Pathologic changes including structural damage to the myenteric plexus, severe and permanent interference with colonic motility, and hypertrophy of the muscularis mucosae may occur with chronic use.^c

Protein-losing enteropathy and steatorrhea can occur.^e

“Cathartic colon” with atony and dilation of the colon, especially of the right side, has occurred with habitual use (often for several years) and often resembles ulcerative colitis.^c

General Precautions

Rectal Administration

Some clinicians state that stimulant laxative suppositories or enemas should not be used in patients with abdominal cramps, anal or rectal fissures, or ulcerated hemorrhoids.^c

Bisacodyl Tannex

Hepatotoxicity may result if sufficient tannic acid is absorbed from bisacodyl tannex laxatives.^c

Bisacodyl tannex should be used with caution, if at all, in patients receiving multiple enemas or in those with extensive ulceration of the colon since increased tannic acid absorption may occur.^c

Fleet Prep Kits

Use with caution kits containing bisacodyl tablets, sodium phosphates oral solution, and bisacodyl suppositories or enemas (Fleet Prep Kits) in patients with heart disease, acute MI, unstable angina, preexisting electrolyte disturbances, increased risk of electrolyte disturbances (e.g., dehydration, gastric retention, colitis, inadequate oral fluid intake, concomitant diuretics or other drugs that affect electrolytes), colostomy, or ileostomy, and in patients who are debilitated, elderly, on a low salt diet, at increased risk for underlying renal impairment, or taking drugs known to prolong the QT interval.^j (See Specific Populations under Cautions.)

Risk of elevated sodium and phosphate concentrations and decreased calcium and potassium concentrations, with resultant risk of hypernatremia, hyperphosphatemia, hypocalcemia, hypokalemia, and acidosis.^j Risk of renal failure and acute phosphate nephropathy.^j

Do not give other sodium phosphate-containing preparations concomitantly.^j

In at-risk patients, consider baseline and posttreatment measurement of sodium, potassium, calcium, chloride, bicarbonate, phosphate, BUN, and creatinine concentrations.^j

Use of Fixed Combination

When used in regimens with other agents, consider the cautions, precautions, and contraindications associated with the concomitant agents.

Specific Populations

Pregnancy

Bisacodyl (base): Category B.^e Bisacodyl tannex: Safety not established.^c

Lactation

May be distributed into the milk of nursing women but usually in amounts insufficient to produce a laxative effect.^{b c e}

Pediatric Use

Stimulant laxatives generally avoided in children <6 years of age for occasional constipation,^c unless otherwise directed by a clinician.^{a f g h i}

Do not use bisacodyl enemas in children <12 years of age.ⁱ

Do not use kits containing bisacodyl tablets, sodium phosphates oral solution, and bisacodyl suppositories or enemas (Fleet Prep Kits) in patients <18 years of age.^{j s t}

Bisacodyl tannex: Because the possibility of tannic acid absorption has not been studied adequately in children <10 years of age, bisacodyl tannex is contraindicated in this age group.^c

Geriatric Use

Use with caution kits containing bisacodyl tablets, sodium phosphates oral solution, and bisacodyl suppositories or enemas (Fleet Prep Kits); consider baseline and posttreatment measurement of sodium, potassium, calcium, chloride, bicarbonate, phosphate, BUN, and creatinine concentrations.^j (See Fleet Prep Kits under Cautions.)

Hepatic Impairment

Do not use kits containing bisacodyl tablets, sodium phosphates oral solution, and bisacodyl suppositories or enemas (Fleet Prep Kits) in patients with ascites.^j

Renal Impairment

Do not use kits containing bisacodyl tablets, sodium phosphates oral solution, and bisacodyl suppositories or enemas (Fleet Prep Kits) in patients with clinically important renal impairment.^j (See Fleet Prep Kits under Cautions.)

Common Adverse Effects

Some degree of abdominal discomfort, nausea, cramps, griping, and/or faintness with therapeutic doses.^c

Diarrhea, GI irritation, and fluid and electrolyte depletion.^c

Gastric irritation and the possibility of vomiting if enteric coating of tablets is disrupted.^b (See Advice to Patients.)

Rectal administration of bisacodyl suspensions or suppositories may cause irritation and a sensation of burning of the rectal mucosa and mild proctitis.^{c e}

Hepatotoxicity if sufficient tannic acid is absorbed from bisacodyl tannex.^c

Risk of electrolyte disturbances with sodium phosphates in kits containing bisacodyl tablets, sodium phosphates oral solution, and bisacodyl suppositories or enemas (Fleet Prep Kits).^j (See Fleet Prep Kits under Cautions.)

Interactions for Bisacodyl

GI Drug Absorption

By increasing intestinal motility, can potentially decrease transit time of concomitantly administered oral drugs and thereby decrease their absorption.^c

Specific Drugs and Foods

Drug or Food	Interaction	Comments
Antacids	Administration of delayed-release (enteric-coated) tablets within 1 hour of antacids results in rapid erosion of the coatingb e	Do not take within 1 hour of antacids since gastric or duodenal irritation can occurb e
Cimetidine	Administration of delayed-release (enteric-coated) tablets within 1 hour of cimetidine results in rapid erosion of the coatingb e	Do not take within 1 hour of cimetidine since gastric or duodenal irritation can occurb e
Milk	Administration of delayed-release (enteric-coated) tablets within 1 hour of milk results in rapid erosion of the coatingb e	Do not take within 1 hour of milk since gastric or duodenal irritation can occurb e
Famotidine	Administration of delayed-release (enteric-coated) tablets within 1 hour of famotidine results in rapid erosion of the coatingb e	Do not take within 1 hour of famotidine since gastric or duodenal irritation can occurb e
Proton-pump inhibitors	Increased gastric pH results in rapid erosion of the coating of delayed-release (enteric-coated) tabletse	Gastric or duodenal irritation can occure
Ranitidine	Administration of delayed-release (enteric-coated) tablets within 1 hour of ranitidine results in rapid erosion of the enteric coatingb e	Do not take within 1 hour of ranitidine since gastric or duodenal irritation can occurb e

Bisacodyl Pharmacokinetics

Absorption

Bioavailability

Absorption of bisacodyl or bisacodyl tannex is minimal following oral or rectal administration.^{b e}

Tannic acid may be absorbed following rectal administration; very little is known about the degree of absorption and circumstances under which absorption may occur with bisacodyl tannex.^b

Onset

Oral therapeutic dosages: evacuation is produced in 6–8 hours (range: 6–12 hours).^{a b e f g i}

Rectally administered bisacodyl or bisacodyl tannex produces evacuation of the colon within 15 minutes to 1 hour.^{b e h i}

Distribution

Extent

Distributes into milk.

Plasma Protein Binding

>99%.

Special Populations

In patients with renal impairment, possible altered protein binding and pharmacokinetics.

Elimination

Metabolism

Any bisacodyl that is absorbed is metabolized in the liver.^b

Elimination Route

Any bisacodyl that is absorbed is excreted in the urine.^b

Stability

Storage

Bisacodyl rectal suppositories and enteric-coated tablets should be stored at less than 30°C.^b Reconstituted solutions of bisacodyl tannex should be used immediately following preparation.^b

Oral

Tablets, Delayed-release (enteric-coated)

In well-closed containers at ≤30°C.^{b d}

Rectal

Suppositories

In well-closed containers at ≤30°C.^{b d}

Suspension

In unit-dose containers at ≤30°C.^{b d}

Actions

• 
  

  Bisacodyl and bisacodyl tannex are diphenylmethane-derivative stimulant laxatives.^{b c e}

  
  


• 
  

  Commonly thought that stimulant laxatives induce defecation by stimulating propulsive peristaltic activity of the intestine through local irritation of the mucosa or through a more selective action on the intramural nerve plexus of intestinal smooth muscle, thus increasing motility.^{c e}

  
  


• 
  

  More recent evidence shows that stimulant laxatives alter fluid and electrolyte absorption, producing net intestinal fluid accumulation and laxation.^c

  
  


• 
  

  Stimulant laxatives mainly promote evacuation of the colon;^c action of bisacodyl on small intestine is negligible.^e

  
  


• 
  

  Bisacodyl acts in the colon on contact with the mucosal nerve plexus.^e

  
  

  Colonic stimulation is segmented and axonal, producing contraction of the entire colon.^e

  
  


• 
  

  Action is independent of intestinal tone.^e

  
  


• 
  

  Tannic acid present in the bisacodyl tannex complex precipitates protein and its astringent effect decreases mucus secretion in the large intestine.^c

  
  

  Tannic acid also reportedly facilitates adherence of contrast media to mucous membranes, but this is disputed by some clinicians.^c

  
  

  Some reports that tannic acid increases evacuation of the colon, but other reports that its astringent effect produces constipation.^c

  
  

Advice to Patients

• 
  

  Importance of swallowing delayed-release (enteric-coated) tablets whole and of not crushing, chewing, or taking within 1 hour of antacids or milk so that gastric irritation and the possibility of vomiting are avoided.^{a b f g h i}

  
  

  Patients who cannot swallow without chewing should not use the delayed-release (enteric-coated) tablets,^{f g} unless otherwise directed by a clinician.^g

  
  


• 
  

  Advise patients that prolonged use can cause excessive loss of fluids, electrolytes, and nutrients.^e

  
  


• 
  

  Importance of not using laxative products for a period longer than 1 week unless directed by a clinician.^{a c f g h i}

  
  


• 
  

  Importance of informing clinicians before use if abdominal pain, nausea, or vomiting is present or if a sudden change in bowel habits that persists over a period of 2 weeks has been noticed.^{a c f g h i}

  
  


• 
  

  Importance of contacting a clinician if a bowel movement does not occur^{a f g h i j} within 12 hours^a or if rectal bleeding occurs since these may be signs of a serious condition.^{a f g h i j}

  
  


• 
  

  Advise patient to open and read directions for bowel cleansing preparations at least 2 days in advance of examination.^{j s t} Importance of following complete regimen for bowel cleansing preparations.^{m o r s t}

  
  


• 
  

  Importance of adequate oral fluid intake when used for bowel cleansing.^{j k l m n o p q}

  
  


• 
  

  Advise about risk of laxative abuse and potential serious consequences.^{c e} (See Chronic Use or Overdosage under Cautions.)

  
  


• 
  

  Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses.

  
  


• 
  

  Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.^{c e i}

  
  


• 
  

  Importance of informing patients of other important precautionary information. (See Cautions.)

  
  

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Bisacodyl

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral	Tablets, delayed-release (enteric-coated)	5 mg*	Alophen Pills	Numark
			Bisac-Evac	G&W
			Bisacodyl Enteric-coated Tablets
			Carter’s Little Pills	Carter
			Correctol Caplets	Schering-Plough
			Correctol Tablets	Schering-Plough
			Dulcolax	Novartis
			Feen-A-Mint	Schering-Plough
			Fleet Bisacodyl	Fleet
Rectal	Suppositories	10 mg*	Bisac-Evac	G&W
			Bisacodyl Suppositories
			Bisacodyl Uniserts	Upsher-Smith
			Dulcolax	Novartis
			Fleet Bisacodyl	Fleet
	Suspension	10 mg/30 mL	Fleet Bisacodyl Enema	Fleet

Bisacodyl Combinations

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
	Kit	4 Tablets, enteric-coated, Bisacodyl 5 mg (Dulcolax) 1 Suppository, rectal, Bisacodyl 10 mg (Dulcolax)	Dulcolax Bowel Prep Kit	Novartis
		45 mL Solution, oral, Dibasic Sodium Phosphate 900 mg/5 mL and Monobasic Sodium Phosphate 2.4 g/5 mL (Fleet Phospho-soda) 4 Tablets, enteric-coated, Bisacodyl 5 mg (Fleet Bisacodyl) 1 Suppository, rectal, Bisacodyl 10 mg (Fleet Bisacodyl)	Fleet Prep Kit 1	Fleet
		45 mL Solution, oral, Dibasic Sodium Phosphate 900 mg/5 mL and Monobasic Sodium Phosphate 2.4 g/5 mL (Fleet Phospho-soda) 4 Tablets, enteric-coated, Bisacodyl 5 mg (Fleet Bisacodyl) 30 mL Suspension, rectal, Bisacodyl 0.33 mg/mL (Fleet Bisacodyl Enema)	Fleet Prep Kit 3	Fleet
		300 mL Solution, oral, Magnesium Citrate 4 Tablets, enteric-coated, Bisacodyl 5 mg 1 Suppository, rectal, Bisacodyl 10 mg	Liquid LoSo Prep Bowel Cleansing System	E-Z-EM
		For solution, oral, Magnesium Citrate 18 g as Magnesium Carbonate, Citric Acid, and Potassium Citrate 4 Tablets, enteric-coated, Bisacodyl 5 mg 1 Suppository, rectal, Bisacodyl 10 mg	LoSo Prep Bowel Cleansing System	E-Z-EM
		300 mL Solution, oral, Magnesium Citrate (Tridrate) 3 Tablets, enteric-coated, Bisacodyl 5 mg (Tridrate) 1 Suppository, rectal, Bisacodyl 10 mg (Tridrate)	Tridrate Bowel Evacuant Kit	Lafayette
		For solution, oral, Magnesium Citrate 19 g 3 Tablets, enteric-coated, Bisacodyl 5 mg (Tridrate) 1 Suppository, rectal, Bisacodyl 10 mg (Tridrate)	Tridrate Dry Bowel Evacuant Kit	Lafayette

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 10/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Bisac-Evac 10MG Suppositories (G & W LABS): 100/$18.97 or 300/$56.91

Bisacodyl 10MG Suppositories (PERRIGO): 100/$25.99 or 300/$65.97

Dulcolax 5MG Enteric-coated Tablets (BOEHRINGER INGELHEIM CONSUMER): 10/$13.99 or 30/$20.97

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug'

BeeGentle Gel

Generic Name: benzocaine

Dosage Form: gel
Product Information BeeGentle™ is a water-insoluble topical anesthetic containing 20% benzocaine which forms an insoluble film upon contact with moist tissue. The film releases benzocaine at a constant rate over a 20-30 minute period. The anesthetic adheres to soft tissue forming a white film that remains in place until physically removed or until slowly dissolved by saliva. This unique time-release benzocaine anesthetic provides longer lasting anesthesia versus conventional water-soluble products. BeeGentle has an ethanol based solvent and is honey flavored.

• Not for use on patients with known sensitivity or allergies to benzocaine or other similar “caine” substances.


• Not for use in pulpectomy procedures or application to exposed roots.


• Ensure the material has had time for the solvent to evaporate and profound anesthesia has occurred.


• For topical use only. Do not inject.
  

• Do not store above 100°F (38°C). Do not freeze. Do not use beyond indicated shelf life.


• Do not use if the packaging has been damaged or if the seals are found to be broken or open.


• Shelf Life: 2 years
  

1. Twist on ViscoTip™ brush tip for easy application.


2. Apply a generous coat of varnish to the treatment site.


3. Wait 2 minutes after application before administering any injections or proceeding with the procedure.


4. BeeGentle™ will release benzocaine for 20-30 minutes.


5. Remove with wet gauze or allow saliva to dissolve.

NOTES:

• If the material needs to be removed from the application site, use a dry cotton pellet or swab to work the material free.


• To reduce the amount of anesthesia, use a dry brush, cotton pellet or swab to thin out the layer of varnish or work the material free.
  

Back page of Complete Instructions:

Caution: Federal law restricts this device to sale by or on the order of a licensed professional.

Disclaimer: CAO Group believes this information to be accurate and is offered only for the benefit of its customers for use of the product under proscribed conditions. This document is not to be considered a warranty or guarantee of product performance, and CAO Group is not legally bound to such claims based on this document.

Manufactured by CAO (China) Medical Equipment Co,. Ltd. for CAO Group. Inc.

P 877.236.4408 F 801.256.9287

4628 West Skyhawk Drive, West Jordan, UT 84084-4501 U.S.A.

www.caogroup.com

SAL-CAI001C.1/22SEP2010

BACK PANEL OF INTRO KIT OUTER PACKAGING

Manufactured by CAO (China) Medical Equipment Co., Ltd. for CAO Group, Inc.

4628 West Skyhawk Drive

West Jordan, UT 84084

U.S.A.

877-236-4408 (tel)

801-256-9287 (fax)

www.caogroup.com

PACKAGE CONTENTS: 3) 3cc preloaded syringes 2) packs of 25 ViscoTips™

See package insert for dosage information.

Rx Only. Dispose of properly after use. For complete safety information see product MSDS.

Do not use if the packaging has been damaged, or if the safety seals are found to be broken.

REORDER #

006-00094

STORAGE: [32°F/0°C to 100°F/38°C]

TO REORDER:

Henry Schein

1.800.372.4346

EXPIRATION DATE: [lot and date label]

[BARCODE #: 872320000745]

PAK-CT0001C.1/22SEP2010

BACK PANEL OF REFILL KIT OUTER PACKAGING

Manufactured by CAO (China) Medical Equipment Co., Ltd. for CAO Group, Inc.

4628 West Skyhawk Drive

West Jordan, UT 84084

U.S.A.

877-236-4408 (tel)

801-256-9287 (fax)

www.caogroup.com

PACKAGE CONTENTS: 20) 3cc preloaded syringes 2) packs of 25 ViscoTips™

See package insert for dosage information.

Rx Only. Dispose of properly after use. For complete safety information see product MSDS.

Do not use if the packaging has been damaged, or if the safety seals are found to be broken.

REORDER #

006-00095

STORAGE: [32°F/0°C to 100°F/38°C]

TO REORDER:

Henry Schein

1.800.372.4346

EXPIRATION DATE: [lot and date label]

[BARCODE #: 872320000752]

PAK-CT0002C.1/22SEP2010

BACK PANEL OF BULK KIT OUTER PACKAGING

Manufactured by CAO (China) Medical Equipment Co., Ltd. for CAO Group, Inc.

4628 West Skyhawk Drive

West Jordan, UT 84084

U.S.A.

877-236-4408 (tel)

801-256-9287 (fax)

www.caogroup.com

See package insert for dosage information.

Rx Only. Dispose of properly after use. For complete safety information see product MSDS.

Do not use if the packaging has been damaged, or if the safety seals are found to be broken.

REORDER #

006-00096

STORAGE: [32°F/0°C to 100°F/38°C]

NET QTY: 30mL

TO REORDER:

Henry Schein

1.800.372.4346

EXPIRATION DATE: [lot and date label]

[BARCODE #: 872320000769]

PAK-CT0003D.1/22SEP2010

SIDE PANEL OF INTRO KIT OUTER PACKAGING

BeeGentle

Honey Flavored Topical Anesthetic

Ingredients: Ethyl alcohol, benzocaine, proprietary polymer thickener, water/eau, honey flavor, sucralose

NDC# 1406000203

SIDE PANEL OF REFILL KIT OUTER PACKAGING

BeeGentle

Honey Flavored Topical Anesthetic

Ingredients: Ethyl alcohol, benzocaine, proprietary polymer thickener, water/eau, honey flavor, sucralose

NDC# 1406000204

SIDE PANEL OF BULK KIT OUTER PACKAGING

BeeGentle

Honey Flavored Topical Anesthetic

Ingredients: Ethyl alcohol, benzocaine, proprietary polymer thickener, water/eau, honey flavor, sucralose

NDC# 1406000202

BeeGentle

Honey Flavored Topical Anesthetic

Introductory Kit

Rapid, Easy Topical Anesthesia You Can See.

Net Qty: 3) 3cc prefilled syringes

Active Ingredient: Benzocaine, 20%

BeeGentle

Honey Flavored Topical Anesthetic

Refill Kit

Rapid, Easy Topical Anesthesia You Can See.

Net Qty: 20) 3cc prefilled syringes

Active Ingredient: Benzocaine, 20%

BeeGentle

Honey Flavored Topical Anesthetic

Bulk Kit

Rapid, Easy Topical Anesthesia You Can See.

Net Qty: 30mL

Active Ingredient: Benzocaine, 20%

BEEGENTLE  TOPICAL ANESTHETIC benzocaine  gel

Product Information Product Type HUMAN PRESCRIPTION DRUG NDC Product Code (Source) 14060-002 Route of Administration TOPICAL DEA Schedule

Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength Benzocaine (Benzocaine) Benzocaine 210 mg  in 1 g

Inactive Ingredients Ingredient Name Strength Water   Alcohol

Product Characteristics Color      Score      Shape Size Flavor HONEY (Honey Flavor (artificial)) Imprint Code Contains

Packaging # NDC Package Description Multilevel Packaging 1 14060-002-03 3 SYRINGE In 1 KIT contains a SYRINGE, PLASTIC 1 3 g In 1 SYRINGE, PLASTIC This package is contained within the KIT (14060-002-03) 2 14060-002-04 20 SYRINGE In 1 KIT contains a SYRINGE, PLASTIC 2 3 g In 1 SYRINGE, PLASTIC This package is contained within the KIT (14060-002-04) 3 14060-002-02 1 BOTTLE In 1 PACKAGE contains a BOTTLE, PLASTIC 3 30 g In 1 BOTTLE, PLASTIC This package is contained within the PACKAGE (14060-002-02)

Marketing Information
Marketing Category	Application Number or Monograph Citation	Marketing Start Date	Marketing End Date
unapproved drug other		09/01/2010

Labeler - CAO Group, Inc. (102422578)

Registrant - CAO Group, Inc. (102422578)

Revised: 10/2010CAO Group, Inc.

More BeeGentle Gel resources

• BeeGentle Gel Side Effects (in more detail)
• BeeGentle Gel Use in Pregnancy & Breastfeeding
• 0 Reviews for BeeGentle - Add your own review/rating

Compare BeeGentle Gel with other medications

• Oral and Dental Conditions

bortezomib

Generic Name: bortezomib (bor TEZ oh mib)

Brand Names: Velcade

What is bortezomib?

Bortezomib interferes with the growth of some cancer cells and keeps them from spreading in your body.

Bortezomib is used to treat multiple myeloma and mantle cell lymphoma.

Bortezomib is sometimes given after other cancer medications have been tried without successful treatment.

Bortezomib may also be used for purposes not listed in this medication guide.

What is the most important information I should know about bortezomib?

Do not use bortezomib if you are pregnant. It could harm the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment. Bortezomib can lower blood cells that help your body fight infections. Your blood may need to be tested often. Avoid being near people who are sick or have infections. Avoid activities that may increase your risk of bleeding injury. Tell your doctor at once if you develop signs of infection.

Avoid becoming dehydrated if you have any vomiting or diarrhea. Symptoms of dehydration include dizziness, dry mouth, fainting, or hot and dry skin. Talk with your doctor about how best to keep yourself hydrated.

This medication may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

What should I discuss with my healthcare provider before receiving bortezomib?

You should not use this medication if you are allergic to bortezomib, mannitol, or boron.

To make sure you can safely receive bortezomib, tell your doctor if you have any of these other conditions:

• 
  

  diabetes;

  
  


• 
  

  liver disease;

  
  


• 
  

  kidney disease, or if you are on dialysis;

  
  


• 
  

  a bleeding or blood clotting disorder;

  
  


• 
  

  a low level of platelets or white or red blood cells;

  
  


• 
  

  heart disease, congestive heart failure;

  
  


• 
  

  herpes or a history of shingles;

  
  


• 
  

  high or low blood pressure; or

  
  


• 
  

  nerve problems such as numbness, burning, pain, or tingly feeling.

  
  

FDA pregnancy category D. Do not use bortezomib if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment. It is not known whether bortezomib passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using bortezomib.

How is bortezomib given?

Bortezomib is injected into a vein through an IV.

You will receive this injection in a clinic or hospital setting. A doctor, nurse, or other healthcare provider will give you this injection.

Bortezomib is usually injected 2 times a week for 2 weeks, followed by 10 days without an injection. Bortezomib may also be given once a week for 4 weeks followed by 13 days without an injection. Follow your doctor's instructions about your individual dosing schedule.

Bortezomib can lower blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. Your blood may need to be tested often. Your liver function may also need to be tested. Visit your doctor regularly.

What happens if I miss a dose?

Call your doctor for instructions if you will miss an appointment for your bortezomib injection.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose may cause weakness, bruising or bleeding, pinpoint red spots on your skin, and fainting.

What should I avoid while receiving bortezomib?

Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.

This medication may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Avoid becoming dehydrated if you have any vomiting or diarrhea. Symptoms of dehydration include dizziness, dry mouth, fainting, or hot and dry skin. Talk with your doctor about how best to keep yourself hydrated.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Bortezomib side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

• 
  

  new or worsening nerve problems such as numbness, burning, pain, weakness, or tingly feeling;

  
  


• 
  

  feeling like you might pass out;

  
  


• 
  

  dry cough and trouble breathing;

  
  


• 
  

  severe headache, vision problems, confusion, and/or seizure (convulsions);

  
  


• 
  

  black, bloody, or tarry stools, vomit that looks like blood or coffee grounds;

  
  


• 
  

  severe constipation;

  
  


• 
  

  easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

  
  


• 
  

  fever, chills, body aches, flu symptoms;

  
  


• 
  

  red bumps, spreading skin rash, painful skin lesions on your arms, face, or neck;

  
  


• 
  

  feeling short of breath, even with mild exertion;

  
  


• 
  

  fast or slow heart rate, weak pulse, lower back pain, blood in your urine;

  
  


• 
  

  urinating less than usual or not at all;

  
  


• 
  

  muscle weakness, tightness, or contraction, overactive reflexes; or

  
  


• 
  

  nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

  
  

Less serious side effects may include:

• 
  

  mild nausea, vomiting, upset stomach;

  
  


• 
  

  diarrhea, constipation, bloating;

  
  


• 
  

  headache, mild dizziness;

  
  


• 
  

  muscle pain, bone or joint pain;

  
  


• 
  

  sleep problems (insomnia);

  
  


• 
  

  mild rash or itching; or

  
  


• 
  

  skin irritation where the medicine was injected.

  
  

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Bortezomib Dosing Information

Usual Adult Dose for Lymphoma:

For use in the treatment of mantle cell lymphoma:

1.3 mg/m2 as a bolus intravenous injection twice weekly for two weeks (days 1, 4, 8, and 11) followed by a ten day rest period (days 12 through 21)

The three week period is considered a treatment cycle.

A minimum of 72 hours should elapse between consecutive doses of bortezomib.

Usual Adult Dose for Multiple Myeloma:

For use in the treatment of previously untreated multiple myeloma:

Usual dose: 1.3 mg/m2 administered as a 3 to 5 second bolus IV injection in combination with oral melphalan and oral prednisone for nine 6-week treatment cycles.

In cycles 1 through 4, bortezomib is administered twice weekly (days 1, 4, 8, 11, 22, 25, 29 and 32). In cycles 5 through 9, bortezomib is administered once weekly (days 1, 8, 22 and 29). At least 72 hours should elapse between consecutive doses of bortezomib.

For use in the treatment of relapsed multiple myeloma:

1.3 mg/m2 as a bolus intravenous injection twice weekly for two weeks (days 1, 4, 8, and 11) followed by a ten day rest period (days 12 through 21)

The three week period is considered a treatment cycle.

A minimum of 72 hours should elapse between consecutive doses of bortezomib.

What other drugs will affect bortezomib?

Many drugs can interact with bortezomib. Below is just a partial list. Tell your doctor if you are using:

• 
  

  dexamethasone (Decadron, Hexadrol);

  
  


• 
  

  rifabutin (Mycobutin), rifampin (Rifadin, Rifater, Rifamate), or rifapentine (Priftin);

  
  


• 
  

  St. John's wort;

  
  


• 
  

  an antibiotic such as clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), or telithromycin (Ketex);

  
  


• 
  

  an antifungal medication such as clotrimazole (Mycelex Troche), itraconazole (Sporanox), ketoconazole (Nizoral), miconazole (Oravig), or voriconazole (Vfend);

  
  


• 
  

  an antidepressant such as nefazodone, paroxetine (Paxil), or sertraline (Zoloft);

  
  


• 
  

  a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Solfoton);

  
  


• 
  

  diabetes medicine you take by mouth (your dose may need to be adjusted when your bortezomib treatment starts);

  
  


• 
  

  HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), efavirenz (Sustiva, Atripla), etravirine (Intelence), indinavir (Crixivan), nelfinavir (Viracept), nevirapine (Viramune), saquinavir (Invirase), or ritonavir (Norvir, Kaletra);

  
  


• 
  

  medicines to treat narcolepsy, such as armodafanil (Nuvigil) or modafanil (Progivil); or

  
  


• 
  

  seizure medicine such as carbamazepine (Carbatrol, Equetro, Tegretol), felbamate (Felbatol), oxcarbazepine (Trileptal), or phenytoin (Dilantin), or primidone (Mysoline).

  
  

This list is not complete and other drugs may interact with bortezomib. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More bortezomib resources

• Bortezomib Side Effects (in more detail)
• Bortezomib Dosage
• Bortezomib Use in Pregnancy & Breastfeeding
• Bortezomib Drug Interactions
• Bortezomib Support Group
• 2 Reviews for Bortezomib - Add your own review/rating

• bortezomib Intravenous Advanced Consumer (Micromedex) - Includes Dosage Information


• Bortezomib Professional Patient Advice (Wolters Kluwer)


• Bortezomib MedFacts Consumer Leaflet (Wolters Kluwer)


• Bortezomib Monograph (AHFS DI)


• Velcade Prescribing Information (FDA)


• Velcade Consumer Overview

Compare bortezomib with other medications

• Lymphoma
• Multiple Myeloma

Where can I get more information?

• Your pharmacist can provide more information about bortezomib.

See also: bortezomib side effects (in more detail)

Babee Cof

Generic Name: dextromethorphan (dex troe meth OR fan)

Brand Names: Babee Cof, Benylin DM Pediatric, Buckley's Mixture Cough Suppressant, Buckleys Mixture, Creo-Terpin, Creomulsion, Delsym, Delsym 12 Hour Cough Relief, Delsym 12 Hour Cough Relief for Children & Adults, DexAlone, Elixsure Cough, Hold DM, Pediacare, Robitussin CoughGels, Robitussin Honey Cough, Robitussin Maximum Strength, Robitussin Pediatric Cough Suppressant, Scot-Tussin Diabetic, Scot-Tussin DM Cough Chasers, Silphen DM, St. Joseph Cough Suppressant, Sucrets DM Cough, Theraflu Thin Strips Cough, Triaminic Long Acting Cough, Triaminic Softchew, Vicks 44 Cough Relief

What is Babee Cof (dextromethorphan)?

Dextromethorphan is a cough suppressant. It affects the signals in the brain that trigger cough reflex.

Dextromethorphan is used to treat a cough.

Dextromethorphan will not treat a cough that is caused by smoking, asthma, or emphysema.

Dextromethorphan may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Babee Cof (dextromethorphan)?

Do not give this medication to a child younger than 4 years old. Always ask a doctor before giving a cough or cold medicine to a child. Death can occur from the misuse of cough and cold medicines in very young children. Do not use dextromethorphan if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take dextromethorphan before the MAO inhibitor has cleared from your body. Do not use any other over-the-counter cough, cold, or allergy medication without first asking your doctor or pharmacist. If you take certain products together you may accidentally take too much of one or more types of medicine. Read the label of any other medicine you are using to see if it contains dextromethorphan. Dextromethorphan will not treat a cough that is caused by smoking, asthma, or emphysema.

What should I discuss with my healthcare provider before taking Babee Cof (dextromethorphan)?

Do not use dextromethorphan if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take dextromethorphan before the MAO inhibitor has cleared from your body.

Ask a doctor or pharmacist about using this medicine if you have emphysema or chronic bronchitis.

This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. This medication may pass into breast milk and could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Artificially-sweetened liquid forms of cough medicine may contain phenylalanine. This would be important to know if you have phenylketonuria (PKU). Check the ingredients and warnings on the medication label if you are concerned about phenylalanine.

How should I take Babee Cof (dextromethorphan)?

Use this medication exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger amounts, or use it for longer than recommended. Cough medicine is usually taken only for a short time until your symptoms clear up.

Do not give this medication to a child younger than 4 years old. Always ask a doctor before giving cough or cold medicine to a child. Death can occur from the misuse of cough or cold medicine in very young children.

Measure the liquid form of this medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Allow the dextromethorphan lozenge or disintegrating strip to dissolve in your mouth.

Drink extra fluids to help loosen the congestion and lubricate your throat while you are taking this medication. Talk with your doctor if your symptoms do not improve after 7 days of treatment, or if you have a fever with a headache, cough, or skin rash.

If you need to have any type of surgery, tell the surgeon ahead of time if you have taken a cough medicine within the past few days.

Store dextromethorphan at room temperature, away from heat, light, and moisture.

What happens if I miss a dose?

Since cough medicine is usually taken only as needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include feeling restless or nervous.

What should I avoid while taking Babee Cof (dextromethorphan)?

Avoid drinking alcohol. It can increase some of the side effects of dextromethorphan. This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid taking diet pills, caffeine pills, or other stimulants (such as ADHD medications) without your doctor's advice. Taking a stimulant together with cough medicine can increase your risk of unpleasant side effects.

Do not use any other over-the-counter cough, cold, or allergy medication without first asking your doctor or pharmacist. Dextromethorphan is contained in many combination medicines available over the counter. If you take certain products together you may accidentally take too much of this medicine. Read the label of any other medicine you are using to see if it contains dextromethorphan.

Babee Cof (dextromethorphan) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using dextromethorphan and call your doctor at once if you have any of these serious side effects:

• 
  

  severe dizziness, anxiety, restless feeling, or nervousness;

  
  


• 
  

  confusion, hallucinations; or

  
  


• 
  

  slow, shallow breathing.

  
  

Less serious side effects are more likely, such as stomach upset.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Babee Cof (dextromethorphan)?

Before taking dextromethorphan, tell your doctor if you are using any of the following drugs:

• 
  

  celecoxib (Celebrex);

  
  


• 
  

  cinacalcet (Sensipar);

  
  


• 
  

  darifenacin (Enablex);

  
  


• 
  

  imatinib (Gleevec);

  
  


• 
  

  quinidine (Quinaglute, Quinidex);

  
  


• 
  

  ranolazine (Ranexa)

  
  


• 
  

  ritonavir (Norvir);

  
  


• 
  

  sibutramine (Meridia);

  
  


• 
  

  terbinafine (Lamisil);

  
  


• 
  

  medicines to treat high blood pressure; or

  
  


• 
  

  antidepressant medications such as amitriptyline (Elavil, Etrafon), bupropion (Wellbutrin, Zyban), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Janimine, Tofranil), paroxetine (Paxil), sertraline (Zoloft), and others.

  
  

This list is not complete and there may be other drugs that can interact with dextromethorphan. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

More Babee Cof resources

• Babee Cof Side Effects (in more detail)
• Babee Cof Use in Pregnancy & Breastfeeding
• Babee Cof Drug Interactions
• Babee Cof Support Group
• 0 Reviews for Babee Cof - Add your own review/rating

• Creo-Terpin Advanced Consumer (Micromedex) - Includes Dosage Information


• Delsym Extended-Release Liquid MedFacts Consumer Leaflet (Wolters Kluwer)


• DexAlone MedFacts Consumer Leaflet (Wolters Kluwer)


• Dextromethorphan Hydrobromide Monograph (AHFS DI)


• ElixSure Cough Gel Syrup MedFacts Consumer Leaflet (Wolters Kluwer)


• Robitussin Maximum Strength Liquid MedFacts Consumer Leaflet (Wolters Kluwer)


• Triaminic Long Acting Cough Orally Disintegrating Strips MedFacts Consumer Leaflet (Wolters Kluwer)


• Tussin Pediatric Elixir MedFacts Consumer Leaflet (Wolters Kluwer)

Compare Babee Cof with other medications

• Cough

Where can I get more information?

• Your pharmacist can provide more information about dextromethorphan.

See also: Babee Cof side effects (in more detail)

Bufferin Extra Strength

Generic Name: aspirin (oral) (AS pir in)

Brand Names: Arthritis Pain, Aspergum Cherry, Aspergum Orginal, Aspir 81, Aspir-Low, Aspirin Lite Coat, Aspirin Litecoat, Aspirin Low Dose, Aspirin Low Strength, Bayer Aspirin, Bayer Aspirin Regimen, Bayer Aspirin Sugar Free, Bayer Aspirin with Calcium, Bayer Childrens Aspirin, Bayer Low Strength, Bayer Plus, Buffered Aspirin, Bufferin, Bufferin Arthritis Strength, Bufferin Extra Strength, Easprin, Ecotrin, Ecotrin Adult Low Strength, Ecotrin Maximum Strength, Fasprin, Genacote, Halfprin, Litecoat Aspirin, Norwich Aspirin, St. Joseph Aspirin, St. Joseph Aspirin Adult Chewable, St. Joseph Aspirin Adult EC, Stanback Analgesic, Tri-Buffered Aspirin, YSP Aspirin, Zorprin

What is aspirin?

Aspirin is in a group of drugs called salicylates (sa-LIS-il-ates). It works by reducing substances in the body that cause pain, fever, and inflammation.

Aspirin is used to treat mild to moderate pain, and also to reduce fever or inflammation. Aspirin is sometimes used to treat or prevent heart attacks, strokes, and chest pain (angina). Aspirin should be used for cardiovascular conditions only under the supervision of a doctor.

Aspirin may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about aspirin?

There are many brands and forms of aspirin available and not all brands are listed on this leaflet.

Aspirin should not be given to a child or teenager who has a fever, especially if the child also has flu symptoms or chicken pox. Aspirin can cause a serious and sometimes fatal condition called Reye's syndrome in children.

Stop using this medication and call your doctor at once if you have any symptoms of bleeding in your stomach or intestines. Symptoms include black, bloody, or tarry stools, and coughing up blood or vomit that looks like coffee grounds.

Avoid drinking alcohol while you are taking aspirin. Alcohol may increase your risk of stomach bleeding.

Aspirin is sometimes used to treat or prevent heart attacks, strokes, and chest pain (angina). Aspirin should be used for cardiovascular conditions only under the supervision of a doctor.

What should I discuss with my healthcare provider before taking aspirin?

Aspirin should not be given to a child or teenager who has a fever, especially if the child also has flu symptoms or chicken pox. Aspirin can cause a serious and sometimes fatal condition called Reye's syndrome in children. Do not use this medication if you are allergic to aspirin, or if you have:

• 
  

  a recent history of stomach or intestinal bleeding;

  
  


• 
  

  a bleeding disorder such as hemophilia; or

  
  


• 
  

  an allergy to an NSAID (non-steroidal anti-inflammatory drug) such as Advil, Motrin, Aleve, Orudis, Indocin, Lodine, Voltaren, Toradol, Mobic, Relafen, Feldene, and others.

  
  

If you have any of these other conditions, you may need a dose adjustment or special tests to safely take aspirin:

• 
  

  asthma or seasonal allergies;

  
  


• 
  

  stomach ulcers;

  
  


• liver disease;


• kidney disease;


• 
  

  a bleeding or blood clotting disorder;

  
  


• 
  

  heart disease, high blood pressure, or congestive heart failure;

  
  


• 
  

  gout; or

  
  


• 
  

  nasal polyps.

  
  

If you are taking aspirin to prevent heart attack or stroke, avoid also taking ibuprofen (Advil, Motrin). Ibuprofen may make aspirin less effective in protecting your heart and blood vessels. If you must use both medications, take the ibuprofen at least 8 hours before or 30 minutes after you take the aspirin (non-enteric coated form). This medication may be harmful to an unborn baby's heart, and may also reduce birth weight or have other dangerous effects. Tell your doctor if you are pregnant or plan to become pregnant while you are taking aspirin. Aspirin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take aspirin?

Use this medication exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger or smaller amounts, or use it for longer than recommended.

Take this medication with a full glass of water. Taking aspirin with food or milk can lessen stomach upset. Enteric-coated aspirin is specially formulated to be gentle on your stomach, but you may take it with food or milk if desired. Do not crush, chew, break, or open an enteric-coated or extended-release pill. Swallow the pill whole. The enteric-coated pill has a special coating to protect your stomach. Breaking the pill could damage this coating. The extended-release tablet is specially made to release medicine slowly in the body. Breaking this pill would cause too much of the drug to be released at one time.

The chewable tablet form of aspirin must be chewed before swallowing.

Keep the orally disintegrating tablet in its package until you are ready to take the medicine. Open the package and peel the back cover from the tablet. Using dry hands, place the tablet into your mouth. It will begin to dissolve right away, without water. Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking aspirin. You may need to stop using the medicine for a short time.

Do not take this medication if you smell a strong vinegar odor in the aspirin bottle. The medicine may no longer be effective. Store aspirin at room temperature away from moisture and heat.

What happens if I miss a dose?

Since aspirin is often used as needed, you may not be on a dosing schedule. If you are using the medication regularly, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include ringing in your ears, headache, nausea, vomiting, dizziness, confusion, hallucinations, rapid breathing, fever, seizure (convulsions), or coma.

What should I avoid while taking aspirin?

Do not use any other over-the-counter medication without first asking your doctor or pharmacist. Aspirin is contained in many medicines available over the counter. If you take certain products together you may accidentally take too much aspirin. Read the label of any other medicine you are using to see if it contains aspirin.

Avoid taking an NSAID (non-steroidal anti-inflammatory drug) while you are taking aspirin. NSAIDs include ibuprofen (Motrin, Advil), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others.

Avoid drinking alcohol while you are taking aspirin. Alcohol may increase your risk of stomach bleeding. Avoid taking ibuprofen (Advil, Motrin) if you are taking aspirin to prevent stroke or heart attack. Ibuprofen can make aspirin less effective in protecting your heart and blood vessels. If you must use both medications, take the ibuprofen at least 8 hours before or 30 minutes after you take the aspirin (non-enteric coated form).

Aspirin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have any of these serious side effects:

• 
  

  black, bloody, or tarry stools;

  
  


• 
  

  coughing up blood or vomit that looks like coffee grounds;

  
  


• 
  

  severe nausea, vomiting, or stomach pain;

  
  


• 
  

  fever lasting longer than 3 days;

  
  


• 
  

  swelling, or pain lasting longer than 10 days; or

  
  


• 
  

  hearing problems, ringing in your ears.

  
  

Less serious side effects may include:

• 
  

  upset stomach, heartburn;

  
  


• 
  

  drowsiness; or

  
  


• 
  

  headache.

  
  

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect aspirin?

Tell your doctor if you are taking an antidepressant such as citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), or venlafaxine (Effexor). Taking any of these drugs with aspirin may cause you to bruise or bleed easily.

Before taking aspirin, tell your doctor if you are using any of the following drugs:

• 
  

  a blood thinner such as warfarin (Coumadin); or

  
  


• 
  

  another salicylate such as choline salicylate and/or magnesium salicylate (Magan, Doan's, Bayer Select Backache Pain Formula, Mobidin, Arthropan, Trilisate, Tricosal), or salsalate (Disalcid).

  
  

This list is not complete and there may be other drugs that can interact with aspirin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

More Bufferin Extra Strength resources

• Bufferin Extra Strength Side Effects (in more detail)
• Bufferin Extra Strength Use in Pregnancy & Breastfeeding
• Bufferin Extra Strength Drug Interactions
• Bufferin Extra Strength Support Group
• 0 Reviews for Bufferin Extra Strength - Add your own review/rating

• Aspirin Monograph (AHFS DI)


• Aspirin Prescribing Information (FDA)


• Aspirin MedFacts Consumer Leaflet (Wolters Kluwer)


• Bayer Low Strength Delayed-Release Tablets MedFacts Consumer Leaflet (Wolters Kluwer)


• Ecotrin Advanced Consumer (Micromedex) - Includes Dosage Information


• ZORprin Controlled-Release Tablets MedFacts Consumer Leaflet (Wolters Kluwer)

Compare Bufferin Extra Strength with other medications

• Angina
• Angina Pectoris Prophylaxis
• Ankylosing Spondylitis
• Antiphospholipid Syndrome
• Aseptic Necrosis
• Back Pain
• Fever
• Heart Attack
• Ischemic Stroke
• Ischemic Stroke, Prophylaxis
• Juvenile Rheumatoid Arthritis
• Kawasaki Disease
• Myocardial Infarction, Prophylaxis
• Niacin Flush
• Osteoarthritis
• Pain
• Prosthetic Heart Valves
• Prosthetic Heart Valves, Mechanical Valves
• Revascularization Procedures, Prophylaxis
• Rheumatic Fever
• Rheumatoid Arthritis
• Sciatica
• Systemic Lupus Erythematosus
• Thromboembolic Stroke Prophylaxis
• Transient Ischemic Attack

Where can I get more information?

• Your pharmacist can provide more information about aspirin.

See also: Bufferin Extra Strength side effects (in more detail)